I have spent my last several posts discussing the shortcoming of standard approaches to the subjective dimension of the SOAP formula. In the next series of post I’ll address the “O”: objective! The doctor’s task conventionally is noting the patient’s subjective vision of the situation, while also recording the objective findings. The cases discussed earlier though show that this is no small task.
What are the criteria for Objectivity? Aside of lab findings and physical aspects noted, other findings would be quite subjective to the doctor.
I suggest demystifying the term “Objective” and using “Observation,” which acknowledges a subjective process. Further, more usefully, let’s revise the “O” to include the Observation of the patient’s objectives and objections.
As seen with the MS patient binding her husband through her disease: She was unwilling to investigate the nature of their relationship and how it affected her health. She believed that so long as she kept him feeling guilty, she would be happy and safe. She used the relationship and what his guilt offered to “deal” with her own overly accommodating and self-sacrificing nature.
MS manifested her healing path; for whatever reason, she chose to look at very short term “benefits.” The underlining problem was not addressed and at some point her strategy was doomed to fail. Recognizing this fact though requires moving beyond conventional ideas of “objective.” In my next post I’ll get into how doctors should proceed to remedy this diagnostic oversight.
